Techniques to Optimize Multimodal Analgesia in Ambulatory Surgery
- 688 Downloads
Purpose of Review
Ambulatory surgery has grown in popularity in recent decades due to the advancement in both surgical and anesthetic techniques resulting in quicker recovery times, fewer complications, higher patient satisfaction, and reduced costs of care. We review common approaches to multimodal analgesia.
A multimodal approach can help reduce perioperative opioid requirements and improve patient recovery. Analgesic options may include NSAIDs, acetaminophen, gabapentinoids, corticosteroids, alpha-2 agonists, local anesthetics, and the use of regional anesthesia.
We highlight important aspects related to pain management in the ambulatory surgery setting. A coordinated approach is required by the entire healthcare team to help expedite patient recovery and facilitate a resumption of normal activity following surgery. Implementation and development of standardized analgesic protocols will further improve patient care and outcomes.
KeywordsPain management Ambulatory Multimodal NSAIDs Opioid Anesthesia Analgesia
Compliance with Ethical Standards
Conflict of Interest
Amit Prabhakar, John N. Cefalu, Josef S. Rowe, and Alan D. Kaye declare that they have no conflicts of interest.
Richard D. Urman received funding from Merck, Mallinckrodt and Medtronic.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 1.White PF. Ambulatory anesthesia advances into the new millennium. Anesth Analg. 2000;90:1235–5.Google Scholar
- 2.Urman RD, Desai SP. History of anesthesia for ambulatory surgery. Curr Opin Anaesthesiol. 2012;25(6):641–7.Google Scholar
- 4.Gritsenko K, Khelemsky Y, Kaye AD, Vadivelu N, Urman RD. Multimodal therapy in perioperative analgesia. Best Pract Res Clin Anaesthesiol. 2014;28(1):59–79.Google Scholar
- 7.Federal Drug Administration. Available online: http://www.fda.gov/Drugs/DrugSafety/ucm381644.htm (accessed on 9 July 2014).
- 23.Merritt CK, Mariano ER, Kaye AD, Lissauer J, Mancuso K, Prabhakar A, et al. Peripheral nerve catheters and local anesthetic infiltration in perioperative analgesia. Best Pract Res Clin Anaesthesiol. 2014;28(1):41–57.Google Scholar
- 24.Tong YC, Kaye AD, Urman RD. Liposomal bupivacaine and clinical outcomes. Best Pract Res Clin Anaesthesiol. 2014;28(1):15–27.Google Scholar
- 27.Covino BG, Scott DB, Lambert DH. Handbook of spinal anaesthesia and analgesia. Philadelphia: WB Saunders; 1994.Google Scholar
- 37.• Bell RF, Dahl JB, Moore RA, et al: Perioperative ketamine for acute postoperative pain, Cochrane Database Syst Rev CD004603, 2006 (online). good review of perioperative ketamine for acute postoperative pain Google Scholar